title: Sclerotic bodies beyond nephrogenic systemic fibrosis.
abstract: Sclerotic bodies are round to oval structures made up of collagen with entrapped elastic fibers, which may be sometimes ossified. These bodies may be found in skin biopsies from patients with nephrogenic systemic fibrosis (NSF), a disease linked to the use of gadolinium in radiologic procedures and chronic renal failure. Sclerotic bodies have not been reported in other diseases. Herein, we report sclerotic bodies as an incidental finding in a re-excision specimen of a squamous cell carcinoma (SCC) from the forearm of an 85-year-old man with chronic renal failure. The patient had had multiple SCC removed over time. Additional clinical history revealed patient having received gadolinium in 2003 and 2004, preceding his dialysis that began in 2009. All of his excision specimens revealed sclerotic bodies in 20 of 30 specimens from 2008. None of the 26 re-excision specimens prior to gadolinium exposure had these bodies. Our findings suggest that sclerotic bodies are the result of gadolinium exposure in patients with chronic renal insufficiency. Because the bodies were found near the re-excision scar, it may be that gadolinium or its metabolites activate fibroblasts in the setting of wound healing. The reasons why this patient did not develop NSF are unclear.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, MA, USA. jbhawan@bu.edu
authors.forename: Jag
authors.initials: J
authors.lastname: Bhawan
authors.forename: Tanya A
authors.initials: TA
authors.lastname: Perez-Chua
authors.forename: Lynne
authors.initials: L
authors.lastname: Goldberg
mesh_terms: D000369:Aged, 80 and over; D005347:Fibroblasts / Q000378:metabolism / Q000473:pathology; D005682:Gadolinium / Q000633:toxicity*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D011859:Radiography; D012867:Skin / Q000378:metabolism / Q000473:pathology; D014945:Wound Healing / Q000187:drug effects
chemical_list: D005682:Gadolinium
keywords: gadolinium; lollipop lesion; nephrogenic systemic fibrosis; osseous metaplasia; sclerotic bodies